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MADELINE ROSE MASTECTOMY BOUTIQUE, LLC
NPI 1316693765
Durable Medical Equipment & Medical Supplies in Vestal, NY

Active since February 24, 2022
100 RANO BLVD, VESTAL, NY 13850(607) 296-2021(607) 296-2023 Get Directions Write a Review

NPPES record last updated: July 26, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 26, 2022, Feb 24, 2022 (2 updates tracked since 2022).

About Madeline Rose Mastectomy Boutique, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MADELINE ROSE MASTECTOMY BOUTIQUE, LLC (NPI 1316693765) is a healthcare organization registered as a durable medical equipment & medical supplies in Vestal, New York and active in the NPI registry since February 2022. The organization lists Jamie Leigh Walck, Owner, as its authorized official.

NPPES Registry Identity

NPI1316693765
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameMADELINE ROSE MASTECTOMY BOUTIQUE, LLC
Location Address100 RANO BLVDVestal, NY 13850-2776
Mailing Address100 Rano BlvdVestal, NY 13850-2776 · (607) 296-2021 · Fax (607) 296-2023
Phone(607) 296-2021
Fax(607) 296-2023
Organization SubpartNo
Authorized OfficialJamie Leigh WalckOwner · (607) 296-2021
Enumeration DateFebruary 24, 2022
Last NPPES UpdateJuly 26, 20222 updates tracked since enumeration
NPPES CertifiedMay 31, 2022
✔ NPI 1316693765 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
Also ListedMastectomy FitterTaxonomy 224900000X
100 RANO BLVD, Vestal, NY 13850
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medical Equipment Supplier Medicare DMEPOS 3

Medicare supplier enrollment and the product categories Madeline Rose Mastectomy Boutique L carries, from the Medicare DMEPOS supplier directory.

Madeline Rose Mastectomy Boutique L

DMEPOS supplier · Vestal, NYOperated by Madeline Rose Mastectomy Boutique LLC
⋮

Does not accept Medicare assignment

Madeline Rose Mastectomy Boutique L has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20402027
Medicare Participant SinceFebruary 23, 2022
Supplier Location100 Rano BlvdVestal, NY 13850
Phone(607) 296-2021
Supplier Specialties
Medical Supply Company Other

Medicare Product Categories

Orthoses: Off-The-Shelf
Met pads, Heel pads, Heel spur pads
Breast Prostheses and/or Accessories
Prosthetic bra, Surgical bra
Lymphedema Compression Treatment Items
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JARRET DANIELS PHARMD
Pharmacist
100 RANO BLVD
VESTAL, NY 13850
Broome County (607) 798-8878
MO WALTS
Pharmacy Technician
100 RANO BLVD
VESTAL, NY 13850
Broome County (607) 763-8712
EVAN ROSS MILLER PHARMD
Pharmacist
100 RANO BLVD
VESTAL, NY 13850
Broome County (607) 798-8878
MRS. JAMIE LEIGH WALCK
Mastectomy Fitter
100 RANO BLVD
VESTAL, NY 13850
Broome County (607) 296-2021
WEIS MARKETS INC
Pharmacy (Community/Retail Pharmacy)
100 RANO BLVD
VESTAL, NY 13850
Broome County (607) 798-8878
JORDAN MAJOR
Pharmacist
100 RANO BLVD
VESTAL, NY 13850
Broome County (607) 798-8878
VALLEY OPTOMETRY PLLC
Optometrist
100 RANO BLVD
VESTAL, NY 13850
Broome County (801) 473-8607

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Madeline Rose Mastectomy Boutique, LLC's NPI number?

The NPI number for Madeline Rose Mastectomy Boutique, LLC is 1316693765. It was assigned to this organization in the NPPES registry on February 24, 2022.

Where is Madeline Rose Mastectomy Boutique, LLC located?

Madeline Rose Mastectomy Boutique, LLC is located at 100 Rano Blvd, Vestal, NY 13850. The listed phone number is (607) 296-2021.

What is Madeline Rose Mastectomy Boutique, LLC's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

Does Madeline Rose Mastectomy Boutique, LLC accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Madeline Rose Mastectomy Boutique L does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

When was this NPI record last updated?

The NPPES record for Madeline Rose Mastectomy Boutique, LLC was last updated on July 26, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.